Mp14-10 Identifying the Optimal Candidate for Concomitant Androgen-Deprivation Therapy Among Patients Receiving Metastasis-Directed Therapy for Positive Psma Pet and Primary or Secondary Biochemical Recurrence From Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-10 IDENTIFYING THE OPTIMAL CANDIDATE FOR CONCOMITANT ANDROGEN-DEPRIVATION THERAPY AMONG PATIENTS RECEIVING METASTASIS-DIRECTED THERAPY FOR POSITIVE PSMA PET AND PRIMARY OR SECONDARY BIOCHEMICAL RECURRENCE FROM PROSTATE CANCER Elio Mazzone, Giorgio Gandaglia, Armando Stabile, Vito Cucchiara, Francesco Barletta, Simone Scuderi, Daniele Robesti, Donato Cannoletta, Antony Pellegrino, Mattia Longoni, Leonardo Quarta, Maria Picchio, Cesare Cozzarini, Arturo Chiti, Andrea Necchi, Daniele Raggi, Pierre I. Karakiewicz, Francesco Montorsi, and Alberto Briganti Elio MazzoneElio Mazzone , Giorgio GandagliaGiorgio Gandaglia , Armando StabileArmando Stabile , Vito CucchiaraVito Cucchiara , Francesco BarlettaFrancesco Barletta , Simone ScuderiSimone Scuderi , Daniele RobestiDaniele Robesti , Donato CannolettaDonato Cannoletta , Antony PellegrinoAntony Pellegrino , Mattia LongoniMattia Longoni , Leonardo QuartaLeonardo Quarta , Maria PicchioMaria Picchio , Cesare CozzariniCesare Cozzarini , Arturo ChitiArturo Chiti , Andrea NecchiAndrea Necchi , Daniele RaggiDaniele Raggi , Pierre I. KarakiewiczPierre I. Karakiewicz , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Whether to use concomitant androgen deprivation therapy (cADT) in prostate cancer (PCa) patients with clinical relapse at PET PSMA is not clear. Thus, we sought to identify the optimal candidates for cADT among positive PSMA PET patients after primary (pBCR) or secondary biochemical recurrence (sBCR) undergoing MDT. METHODS: Overall, 383 PSMA PET staged men for BCR after RP±RT between 2016-2023 at a single Institution were retrieved. Patients receiving adjuvant RT were excluded. Among patients with positive PET, only those receiving MDT (n=120; n=57 pBCR and n=63 sBCR) were included. MDT consisted of stereotactic ablative radiation therapy (SABR) on positive spots, either nodal, bony or visceral. Study outcome was clinical recurrence (CR), defined as new metastases detected at imaging after first PSMA PET. Multivariable Cox regression (MCR) analyses investigated the association between BCR type, cADT at MDT and CR using. To identify the optimal candidates for ADT, a regression tree analysis (RTA) predicting 2-yr CR was used to stratify patients into risk groups based on location (pelvic vs non-pelvic nodes or distant metastases) and number of PSMA spots. Kaplan-Meier (KM) and MCR analyses tested the impact of ADT on CR in each risk group, before and after stratification according to pBCR vs sBCR. RESULTS: Overall, 78 (65%) positive PSMA PET, MDT-treated patients received cADT. No differences were observed between ADT groups (p≥0.1). Overall, 37 patients experienced disease progression. At KM, 2-yr CR-free survival was 75%. At MCR, patients with sBCR had higher CR rates (HR, 2.87; p<0.001). The RTA identified three risk groups with good discrimination accuracy (c-index 77%). When patients were stratified into risk groups, only two groups of patients benefited from ADT: (1) patients with ≥2 pelvic nodal spots (HR, 0.78; p=0.002); and (2) patients with distant extra-pelvic spots (HR, 0.40; p=0.03), regardless of other disease characteristics. Results were confirmed after stratification according to pBCR vs sBCR. CONCLUSIONS: Patients with≥2 nodal or distant spots represent the ideal candidates for intensification treatment with ADT during MDT, either in case of pBCR or sBCR after RP. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e223 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Armando Stabile More articles by this author Vito Cucchiara More articles by this author Francesco Barletta More articles by this author Simone Scuderi More articles by this author Daniele Robesti More articles by this author Donato Cannoletta More articles by this author Antony Pellegrino More articles by this author Mattia Longoni More articles by this author Leonardo Quarta More articles by this author Maria Picchio More articles by this author Cesare Cozzarini More articles by this author Arturo Chiti More articles by this author Andrea Necchi More articles by this author Daniele Raggi More articles by this author Pierre I. Karakiewicz More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...